The American Dietetics Association used to hate “nutritionists”. They have recently changed the name to the Academy of Nutrition and Dietetics — but they still want control over what you eat. Currently the ADA lobbyists are attempting to patch together a national compact for interstate licensing, but many of their state bills attempt to exclude other qualified practitioners from the field. Read more below.
The Dietitian Licensure Interstate Compact
Frequently Asked Questions
Does the dietetics compact increase access by the public to nutrition services?
No. The United States averages only one dietitian per 3,000 residents, and that average is fairly consistent across all states. All states are underserved by dietitians, so most nutrition services are provided by non-dietetic nutrition professionals. Rural and poor communities have significantly less access to nutrition services. The dietetics licensure compact risks further reducing access to nutrition services unless other nutrition service providers are recognized for their importance and their right to practice is protected by the compact.
Does the dietetics compact assist dietitians to provide services and develop their individual practices?
Maybe. Dietitians who live near state borders, spend part of the year in other than their home state, or relocate to a new home state, may be able to practice as dietitians in other than their home state. A dietitian may also provide dietetic services remotely via digital communication to residents of other states. However, few states currently prevent a dietitian from practicing without formal licensure.
What is the role of the state licensing board for dietetics?
Licensure laws typically establish a review board comprised of dietitians to manage potential misconduct by participating dietitians. Note that significant misconduct rarely, if ever, occurs, and disputes over matters like client billing and payment are handled through other established civil methods.
The ostensible role of a dietetics board is to prevent other nutrition professionals from claiming to be dietitians. No state licensure scheme has made it illegal for dietitians to practice their profession of nutrition without being licensed. Most dietitians continue to practice as nutritionists while declining dietetic licensure. Dietetic boards are often justified by the need to protect the public from misuse of the title dietitian professional titles, but in reality, this need has never been demonstrated.
Do dietetic boards and compacts elevate the standards of practice for nutrition services within their states?
No. Behind every effort to establish dietetics regulations at the state level is the American Dietetic Association (ADA). Since its founding, the core tenet of the ADA has been to denigrate mere “nutritionists” as less qualified than dietitians. The elevation of dietetics over holistic nutrition is recognized as the organization’s primary reason for being. The ANA attempted to associate dietetics with scientific principles as legitimized by the federal government to create credibility and public trust for its brand. That science continues to be outdated after decades of institutional inertia and manipulation by outside interests. The link between dietetics and junk food, compromised regulators, and poor health outcomes — best represented by unhealthy hospital food — has created a reputational crisis for dietitians. The rebranded Academy of Nutrition and Dietetics attempts to divorce the organization from its past by elevating nutrition as a part of, but still apart from, dietetics. Similarly, the use of the novel title “registered dietitian nutritionist” reflects the need to reestablish relevance with the American public.
Neither state dietetic oversight boards nor the dietetic licensure compact address this disconnect. The exclusive elevation of dietetics over modern nutrition runs the risk of continuing to jeopardize public health outcomes.
Does the dietetics compact require mandatory participation?
Participation in the dietetics compact itself is not yet mandatory for states or individual dietitians. A state that intends to become a member of the dietetics compact must have a formal licensure system. However, dietitians must be licensed in their home state prior to using the compact to achieve licensed status in other states that are a members of the same compact.
Why would a dietitian seek licensure in more than one state?
The mechanics of dietitian licensure is different in every state that has chosen to enact such a program. In states that require individuals to be licensed as a condition of using one the dietetic professional titles, the compact would allow an individual to achieve title recognition efficiently from state to state. In the very few states restrict the provision of nutrition services without a dietetics license, achieving licensed status would be easier under the compact and allow the individual to seek work with less cost and interruption.
The nature of conventional dietetics services also lends itself to remote interventions by telephone and video conferencing. The rise in telehealth as a cost-reduction measure within the highly concentrated healthcare delivery industry is a good fit with most dietitians’ scope of training and the term “registered dietitian” is recognized by the public, which may help adoption of telehealth services.
Does the absence of a dietetic compact in a state prevent dietitians from practicing outside of their home state?
No. Most state dietetic registration and licensing programs do not require registration or licensure as a condition of providing nutrition services to the public. The majority of dietitians who are eligible to seek dietetics licensure choose not to do so. The compact is not required to provide dietetics services in multiple states.
In what situations is the practice of dietetics required by state or federal authorities?
Licensure may help a dietitian obtain formal recognition by certain institutions that prefer to contract with licensed dietitians, such as some schools and hospitals and government agencies. However, there is no federal requirement that meal planning in hospitals, schools, the military, or other institutions must be performed or overseen by a dietitian.
Doesn’t the dietetics compact prevent unqualified individuals from masquerading as dietitians?
Registration and licensure of dietitians duplicates the title protection provided by federal trademark law. An individual using the dietetic titles without authority is subject to civil action in federal court with or without the state dietetic board or interstate dietetic compact.
An institution whose policies require or give preference to a registered dietitian to perform a particular role will verify the academic credentials and registration status of the individual with the Academy of Nutrition and Dietetics. This is the same process by which nurses, physicians, and medical specialists are vetted through their national accreditation service prior to hiring.
Is there a public health imperative to creating a dietetic interstate compact?
No. It appears that most of the dietetics compact commission’s work will be to maintain a permanent and updated record of any malfeasance by the dietitians licensed by its member states, but malpractice by nutrition providers is exceedingly rare. There is also significant emphasis on biometric background checks and cross-agency coordination between regulators and law enforcement to exclude potentially bad actors from using the compact to obtain the right to practice using a dietetics title they are not entitled to use. Dietetics titles are protected under federal trademark law and do not depend on the dietetic compact.
Nothing in the current dietetics compact or state licensing regimes prevents a dietitian from dropping out of formal licensure and continuing to provide nutrition services with or without the dietetic compact.
Finally, measures of of performance, productivity, and efficacy are not reported or tracked under the dietetic compact.
Does the dietetics licensure compact template prevent non-dietitians from providing nutrition services to the public?
Yes and no. Under the dietetics compact, only nutrition practitioners sanctioned by the ANA/AND can be licensed, therefore potentially preventing the majority of nutritionists from offering nutrition services to communities. Although only a few states have this exclusive scope of practice in place for dietitians, the dietetics compact sets the stage for an exclusive dietetic licensure scheme in the future.
Existing interstate licensing compacts are held up as examples of the benefits of the proposed dietetic compact, but is this comparison accurate?
No. The partial list of active licensure compacts shown in the table below recognizes the validity of an independent national licensing examination that is open to any individual who has completed the required academic curriculum. In contrast, no nutritionist is eligible to take the dietetics examination unless he or she has completed a privately controlled curriculum approved by ANA/AND, an organization that does not recognize any other course of nutrition study regardless of its rigor and quality. Instead of embracing all nutrition practitioners, the dietetics group only recognizes the narrow dietetics practice. To understand this fundamental difference, imagine if the interstate medical licensure compact were to admit only internists while excluding all other specialized areas of practice.
| Profession | Core Education Requirements | Core Testing Requirements | |
| EMT | Currently require the use of the National Registry of Emergency Medical Technicians (NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels | Possess a current unrestricted license in a member state as an EMT, AEMT, paramedic, or state recognized and licensed level with a scope of practice and authority between EMT and paramedic; | |
| Nurse | Has graduated or is eligible to graduate from a board-approved RN or LPN/VN prelicensure education program; May not enroll in an alternative compact. | Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or recognized predecessor; | |
| Medical | A full and unrestricted license to engage in the practice of medicine issued by a member board | Successfully completed graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association | |
| Psychology | Hold a graduate degree in psychology from an institution that meets the requirements laid out in the compact; | Possess a current, full and unrestricted license to practice psychology in a home state that is part of the compact | |
| Audiology | After 2008, has graduated with a doctoral degree in audiology, or equivalent degree regardless of degree name, from a program that is accredited by an accrediting agency recognized by the Council for Higher Education Accreditation, or its successor, or by the United States Department of Education and operated by a college or university accredited by a regional or national accrediting organization recognized by the board; | Has successfully passed a national examination approved by the commission; | |
| SPEECH-LANGUAGE PATHOLOGIST | Has graduated with a master’s degree from a speech-language pathology program that is accredited by an organization recognized by the United States Department of Education and operated by a college or university accredited by a regional or national accrediting organization recognized by the board; | Has successfully passed a national examination approved by the commission | |
Does the dietetics compact increase the availability of dietetic services to the general population?
No. The dietetics compact includes a very narrow subset of nutrition providers. The total number of dietitians in each state is listed in the table below. The national average is one dietitian per 3,054 residents. This compares to one MD per 307 residents. The number of dietitians will continue to decrease as older practitioners retire, and the additional master’s degree requirement will reduce the number of individuals eligible for registration.
| State / US | Population | Number of Dietitians | Residents Per Dietitian | Number of MDs | Residents Per MD | ||
| US Total | 338,120,586 | 110,707 | 3,054 | 1,100,101 | 307 | ||
| Alabama | 5,108,468 | 1,498 | 3,410 | 13,050 | 391 | ||
| Alaska | 733,406 | 258 | 2,843 | 1,917 | 383 | ||
| Arizona | 7,431,344 | 2,156 | 3,447 | 19,814 | 375 | ||
| Arkansas | 3,067,732 | 943 | 3,253 | 8,162 | 376 | ||
| California | 38,965,193 | 11,724 | 3,324 | 119,087 | 327 | ||
| Colorado | 5,877,610 | 2,848 | 2,064 | 15,088 | 390 | ||
| Connecticut | 3,617,176 | 1,523 | 2,375 | 17,178 | 211 | ||
| Delaware | 1,031,890 | 352 | 2,932 | 3,357 | 307 | ||
| Wash DC | 678,972 | 235 | 2,889 | 8,313 | 82 | ||
| Florida | 22,610,726 | 6,041 | 3,743 | 62,346 | 363 | ||
| Georgia | 11,029,227 | 2,662 | 4,143 | 27,315 | 404 | ||
| Hawaii | 1,435,138 | 446 | 3,218 | 4,558 | 315 | ||
| Idaho | 1,964,726 | 756 | 2,599 | 3,327 | 591 | ||
| Illinois | 12,549,689 | 4,330 | 2,898 | 47,785 | 263 | ||
| Indiana | 6,862,199 | 2,168 | 3,165 | 17,875 | 384 | ||
| Iowa | 3,207,004 | 1,096 | 2,926 | 9,593 | 334 | ||
| Kansas | 2,940,546 | 1,005 | 2,926 | 8,235 | 357 | ||
| Kentucky | 4,526,154 | 1,369 | 3,306 | 12,663 | 357 | ||
| Louisiana | 4,573,749 | 1,430 | 3,198 | 14,673 | 312 | ||
| Maine | 1,395,722 | 508 | 2,747 | 5,030 | 277 | ||
| Maryland | 6,180,253 | 1,969 | 3,139 | 26,472 | 233 | ||
| Massachusetts | 7,001,399 | 3,145 | 2,226 | 39,417 | 178 | ||
| Michigan | 10,037,261 | 3,620 | 2,773 | 44,314 | 227 | ||
| Minnesota | 5,737,915 | 2,516 | 2,281 | 19,461 | 295 | ||
| Mississippi | 2,939,690 | 799 | 3,679 | 7,272 | 404 | ||
| Missouri | 6,196,156 | 2,115 | 2,930 | 23,236 | 267 | ||
| Montana | 1,132,812 | 483 | 2,345 | 2,389 | 474 | ||
| Nebraska | 1,978,379 | 761 | 2,600 | 5,987 | 330 | ||
| Nevada | 3,194,176 | 745 | 4,287 | 6,898 | 463 | ||
| New Hampshire | 1,402,054 | 634 | 2,211 | 4,506 | 311 | ||
| New Jersey | 9,290,841 | 3,510 | 2,647 | 33,406 | 278 | ||
| New Mexico | 2,114,371 | 458 | 4,617 | 6,260 | 338 | ||
| New York | 19,571,216 | 7,323 | 2,673 | 101,861 | 192 | ||
| North Carolina | 10,835,491 | 3,885 | 2,789 | 31,043 | 349 | ||
| North Dakota | 783,926 | 393 | 1,995 | 2,268 | 346 | ||
| Ohio | 11,785,935 | 4,775 | 2,468 | 46,816 | 252 | ||
| Oklahoma | 4,053,824 | 1,191 | 3,404 | 10,619 | 382 | ||
| Oregon | 4,233,358 | 1,376 | 3,077 | 12,885 | 329 | ||
| Pennsylvania | 12,961,683 | 5,113 | 2,535 | 56,570 | 229 | ||
| Rhode Island | 1,095,962 | 490 | 2,237 | 5,878 | 186 | ||
| South Carolina | 5,373,555 | 1,420 | 3,784 | 14,108 | 381 | ||
| South Dakota | 919,318 | 338 | 2,720 | 2,258 | 407 | ||
| Tennessee | 7,126,489 | 2,380 | 2,994 | 20,155 | 354 | ||
| Texas | 30,503,301 | 7,989 | 3,818 | 71,740 | 425 | ||
| Utah | 3,417,734 | 1,268 | 2,695 | 7,438 | 459 | ||
| Vermont | 647,464 | 291 | 2,225 | 2,489 | 260 | ||
| Virginia | 8,715,698 | 2,615 | 3,333 | 25,707 | 339 | ||
| Washington | 7,812,880 | 2,791 | 2,799 | 23,366 | 334 | ||
| West Virginia | 1,770,071 | 394 | 4,493 | 5,866 | 302 | ||
| Wisconsin | 5,910,955 | 2,387 | 2,476 | 18,805 | 314 | ||
| Wyoming | 584,057 | 185 | 3,157 | 1,245 | 469 |
How many interstate compacts are under way?
Here is the full list of active compacts according to the National Center for Interstate Compacts that have some number of states signed on.
- Advance Practice Registered Nurse Compact
- Audiology and Speech-Language Pathology Interstate Compact*
- Cosmetology Compact*
- Counseling Interstate Licensure Compact*
- Dentist and Dental Hygienist Compact*
- Emergency Medical Services Compact
- Interstate Medical Licensure Compact
- Interstate Teacher Mobility Compact*
- Massage Therapy Compact*
- Nurse Licensure Compact
- Occupational Therapy Compact*
- Physical Therapy Compact
- Physician Assistant Licensure Compact (PA Compact)*
- Psychology Interjurisdictional Compact*
- Social Work Compact*
- School Psychologists Compact *
- Respiratory Therapists Compact *
These compacts allow any individual to be recognized by participating member states once they have completed an approved course of study (when required) and passed an exam recognized by the compact commission for that profession.
Does the American Dietetic Association (now the Academy of Nutrition and Dietetics) exclude any nutrition curriculum that is not aligned with its dietetic focus?
Yes. The ADA/AND has consistently worked against recognition of nutrition curricula that do not comply with the narrow practice of dietetics. Similarly, the ADA/AND has consistently downplayed the professional stature of nutrition practitioners regardless of the rigor and quality of their unique courses of study. The hidden danger in the dietetics licensure compact is that the ADA/AND will attempt to elevate dietetics as the only valid approach to nutrition and nutrition services.
The Council on Foods and Nutrition of the American Medical Association provides the following broad and inclusive definition of nutrition practice:
Nutrition is the science of food, the nutrients, and other substances therein, their action, interaction, and balance in relation to health and disease and the processes by which the organism ingests, digests, absorbs, transports, utilizes, and excretes food substances. In addition, nutrition must be concerned with certain social, economic, cultural, and psychological implications of food and eating. […] In reviewing specific providers, it must be recognized that terms such as “nutritionist,” “dietitian,” and “nutrition professional” can have varied definitions, however all refer to professionals who practice in the field of nutrition.
What tenets of nutrition are common between all approaches to providing nutrition services?
According to the National Institutes of Health,
“…nutrition professionals have in-depth knowledge about the role of food and nutrition in the prevention, treatment, and progression of acute and chronic disease and, likewise, how disease and treatment affect food and nutrition needs. They must also have knowledge about nutrient composition and preparation of food; alternate feeding modalities; and the socioeconomic, psychological, and educational factors that affect the food and nutrition behavior of people across the lifespan. Lastly, they must have skills to translate scientific information into laymen’s terms and assist individuals in gaining knowledge, self-understanding, and improved decision making and behavior change skills.”
This definition recognizes the value of all services offered by qualified nutrition professionals. Indeed, it describes the holistic nature of nutrition that exceeds the narrower focus of dietetics.
What tenets of dietetics set it apart from other approaches to providing nutrition services?
The practice of dietetics focuses on application of the Dietary Guidelines for Americans (USDA and DHHS) and/or the U.S. Preventive Services Task Force (USPSTF.) According to the NIH, dietetics consultations can often be completed in 1-2 minutes in a clinical setting by matching the client’s status to the USDA and USPSTF framework. The dietitian in a clinical setting may communicate only once with a client / patient, after which recommendations are implemented by the commissary staff or the client themselves. Dietetics rarely excludes highly processed foods, including sugar and general carbohydrates, from dietary recommendations and meal planning. The concept of “balance” between better nutrition and indulgent ingredients is the baseline recommendation provided by a large number of multi-national food brands that financially support the ADA/AND. As such, insulin injections are accepted as a required post-meal treatment to offset increased blood sugar, a practice now endorsed by some mainstream medical authorities.
In contrast, most other nutrition disciples have a broader holistic framework that includes social, economic, behavioral, and other aspects of the person or group being engaged with. Many other nutrition disciplines commit to at least an hour for an initial intake interview, with ongoing follow-up appointments as needed. Modernized nutrition seeks to support client health by recommending whole foods, limiting refined and sugary foods, increasing appropriate physical exercise, and facilitating positive social interaction. Nutrition advice may be provided in coordination with the primary care healthcare providers and may be informed by testing for nutrient deficiencies, food sensitivities, and environmental contaminants.
Do hospitals and other healthcare providers require the services of registered dietitians?
NO. Institutions that are required to comply with current federal nutrition guidelines typically prefer to contract with individuals guided primarily by those rules and procedures, such as dietitians. Some federal agencies recommend registered dietitians provide certain services to ensure those services are reimbursed by some government insurance programs. However, a number of nutrition providers have training and experience that exceeds that of the dietetic curriculum, so many health care institutions recognize and rely on the broader pool of trained professionals to fulfill these duties.
How does the AMA define nutrition services?
Council on Foods and Nutrition of the American Medical Association has defined the field of nutrition in the following manner:
Nutrition is the science of food, the nutrients, and other substances therein, their action, interaction, and balance in relation to health and disease and the processes by which the organism ingests, digests, absorbs, transports, utilizes, and excretes food substances. In addition, nutrition must be concerned with certain social, economic, cultural, and psychological implications of food and eating.
Of note, in the early 1960’s the American Dietetic Association convinced Congress to fund a study of the role of dietetics and dietitians in health care. The commission convened for this purpose refused to focus solely on dietitians, however, because it found that “…other health professionals [are] necessary to adequately provide nutrition services.”
Is “dietetics” a recognized medical specialty?
No. Dietetics may be recognized as an adjunct to the primary care team, but there are many other trained professionals who are also recognized to provide nutrition analysis and recommendations to the care team, and counseling to the patient.
Is it the goal of the dietetics compact to elevate dietetics to a medical specialty?
Yes. This appears to be the case. The dietetics compact is the project of the American Dietetic Association (now Academy of Nutrition and Dietetics). This group was founded to elevate dietetics over all other approaches to nutrition by creating a standardized, least-common-denominator nutrition methodology that physicians would accept as “scientific”. But the role of the dietitian has been relegated to meal planning by most physicians because few physicians include food in their treatment plan beyond reducing salt and carbohydrate intake.
What is the difference between nutrition services generally and “nutrition therapy”?
The healthcare community recognizes that general nutrition advice, counseling, and education is critical to public health outcomes. Three qualities create the circumstances to qualify as nutrition therapy: first, the patient is in a chronic or critical disease state; second, the nutrition therapy is undertaken as part of the overall health care team; and third, the nutrition therapy takes place in a clinical setting under the direction of a physician. In short, a patient’s critical medications and other medical treatments may be supported by nutritional directives but must not interfere with them. During the administration of nutrition therapy, it is the physician who maintains responsibility for the health and health outcomes of the patient.
What is the ADA/AND definition of nutrition therapy?
The ADA/AND has established hundreds of competing definitions of “medical nutrition therapy” while proposing state-level legislation in favor of dietetics licensing and scope of practice over the last several decades. The narrowest definitions range from a keen focus on enteric (tube) feeding using specially formulated liquified foods in a clinical setting. The widest definitions include every potential aspect of nutrition services, beginning with the provision of basic knowledge. As important as these distinctions are, medical nutrition therapy is not transparently defined in the dietetics compact standard template language.
Does the dietetics compact commission define nutrition therapy?
No, but there are three additional steps to answering this question. First, state legislators and regulators will promulgate these and other definitions while passing the dietitian licensing laws required to participate in the dietetics compact. Once a state becomes a member of the dietetics compact, however, state laws are automatically overruled and replaced by the decisions of the dietetics compact commission. A state that does not comply with the commission may be ejected from the compact. In short, nutrition therapy generally and medical nutrition therapy specifically will be defined at an unspecified later time by a third-party commission based in Washington, DC, which represents interests of the ANA/AND.
Will the dietetics licensure commission attempt to establish an exclusive scope of practice only available to dietitians?
Yes. The end goal of the compact is to eliminate recognition of other equally or more qualified nutrition professionals by institutions that are dependent on federal funds, especially for Medicare reimbursement. PhD level practitioners such as Certified Nutrition Specialists may be able to practice alongside physicians but may not be paid by Medicaid or other insurance. Community nutrition educators and counselors who are not part of the ANA/AND regime will also not be recognized. The dietetics compact language should always be read alongside the various federal ANA/AND bills in Congress, which are written to achieve and formalize this outcome.
Are assisted care facilities considered a clinical setting for nutrition therapy?
It depends. Patients admitted to long-term care facilities who are not likely to recover from a disease or injury are typically supported according to Medicare rules and payment schedules This severely limits the resources available to care for them using significant nutritional interventions or nutrition therapy. In addition, physician oversight is extremely limited, making medical nutrition therapy inappropriate or unaffordable for this type of patient.
Patients admitted to hospital or non-hospital care facilities for treatment and rehabilitation pending eventual recovery and release may be eligible for insurance or Medicare reimbursement for nutritional interventions, making medical nutrition therapy more likely to be approved by the care team.
What is the American Medical Association’s position on the dietetics compact?
The AMA has not addressed the dietetics compact publicly, but the AMA admits that it has failed to train many generations of doctors on the role and importance of nutrition in health outcomes. With the ascendence of pharmacological interventions over holistic care, doctors are tasked with matching symptoms to drugs rather than identifying root causes of chronic physical and mental disease. The AMA has yet to increase the minimum nineteen hours of nutrition study required by most medical schools, however. It will likely take another new generation of medical educators before recognizing that optimizing lifelong nutrition must be a core tenet of healthcare. The exigencies of for-profit, pharmaceutical-dependent, healthcare companies do not support the provision of holistic nutrition services. The nominal time allocated for a nutritional consult in a clinical setting is 1-2 minutes. In addition, testing for nutrient levels in blood, and supplementation beyond a few essential vitamins and minerals remains rare.
However, the new specialty of “functional medical doctor” is becoming more common. The Institute for Functional Medicine states:
Functional medicine is a systems biology–based approach that focuses on identifying and addressing the root cause of disease. Each symptom or differential diagnosis may be one of many contributing to an individual’s illness.”
Genetic, epigenetic, environmental, social and nutritional factors are now widely understood to affect overall health and well-being over a lifespan. The Accreditation Council for Continuing Medical Education (ACCME) now recognizes this medical specialty, for which physicians can achieve board certification.
What is the insurance industry’s position on the dietetics compact?
The insurance industry depends on standardization of titles, diagnoses, standards of care, and who can provide that care at what price. Dietetics has successfully standardized its practices and standards to fit into the current healthcare system and be eligible for insurance reimbursement for certain services under certain circumstances. Traditionally these payments have been very low and not readily approved. Overall, the dietetics compact does not directly impact insurers, since professional licensing remains at the state level whether a licensure compact exists or not. The most likely benefit is the ability for certain dietitians to provide telehealth nutritional counseling through health plans more cost effectively across state lines, similar to nursing help lines. Qualified nutritionists can also fulfill these roles.
What is the US military’s position on the dietetics compact?
The Department of Defense contracted with the Council of State Governments’ National Center for Interstate Compacts to undertake a stakeholder process with the goal of drafting an interstate licensure compact to benefit spouses of active-duty members who provide professional nutrition services. The original intent did not specify an exclusive focus on dietetics and dietitians at the expense of other qualified nutrition practitioners. The CSG decided to partner with the ANA/AND as its primary and principal stakeholder, which appears to have informed the dietetic compact’s unwillingness to benefit the wider nutrition profession. The DOD has not reviewed or commented on the final draft recommendation that resulted from this study. Since many spouses of active-duty personnel provide nutrition services outside of the limited ANA/AND dietetic approaches, the DOD likely is not satisfied with the current outcome.
Did the ADA/AND alter the language of the original interstate compact template to encompass only dietetics?
Yes. The ADA/AND restricted access to interstate licensure for nutrition professionals by recognizing only the dietetic curriculum controlled by the ADA/AND as an allowed course of study, and by recognizing only an individual licensed as a dietitian to participate in the compact.
In contrast, the original model interstate professional licensure compacts recognizes that there are many different valid courses of professional education to qualify for licensure, and thus describes the key subjects in which a particular type of practitioner must prove adequate education and training. The model compact reads:
Licensed professional[s] who do not hold degrees in [their field] but in a closely related field are potentially eligible to apply for a privilege if they meet all requirements for licensure as a licensed professional … in their home state
Had the ANA/AND followed the original intent of the compact model, the dietetics licensure compact would be called the Nutrition Services Compact and allow a broader group of competent trained professionals to participate in interstate licensure.
Similarly, the other licensure compacts leave open which professional examinations are allowed to meet the requirements of interstate licensure. There are many professional nutrition examinations available and the ANA/AND could have asked the compact commission to recognize and approve them, but the ANA/AND only recognized the dietetics examination that it controls, writes, and administers – and is only open to candidates who have completed the ANA/AND controlled curriculum.
Generally, the state licensure bills sponsored by the ANA/AND do not recognize the value of other courses of study, examinations, and nutrition professionals. Since the ANA/AND does not support licensure of other nutrition professionals in general, it appears unable to support other nutrition professionals within the context of the dietetic licensure compact.
Are there simpler ways to achieve interstate licensure than surrendering state sovereignty to the ANA/AND dietetic compact commission?
Yes. For example, Kansas already has an elegant mutual recognition clause in its dietitian licensure statutes.
65-5910. Licensure of person licensed in another state. The secretary may license, without examination, any person who is duly licensed in another state if the standards for licensure in such other state are not less than the standards for licensure under this act.
This section would apply to spouses of active-duty military personnel as well.
Can my state move forward with the dietetic compact while safely protecting the right to practice of other nutrition professionals?
Probably. If the dietetic compact commission acts in good faith to promote the dietetic specialty without deprecating other nutrition practitioners, your state’s nutrition professionals may be safe. However, since the dietetics compact gives control of key parts of state licensure laws to the compact commission, your state should:
- Reserve the ability to recognize the right of other nutrition professionals to practice to the level of their training and expertise and qualifications.
- Reserve the right to participate in a nutrition services interstate licensing compact separate from the dietetic compact.
- Include a significant safe harbor exemption in the dietetic compact legislation or companion bill
- Include a straightforward mutual recognition clause in any other licensure bills under consideration.
- Define medical nutrition therapy as services delivered only in a clinical setting under supervision of a physician.
Note that some states have drafted dietetic compact bills that specifically make it illegal for anyone except dietitians to provide any form of nutrition services in the state. If the dietetic compact commission and the ANA/AND succeed in passing this kind of broad exclusionary provision in your state, the negative consequences for other nutrition practitioners and the citizens that rely on them could be dire. Your state cannot depend on good faith in this matter.
What does a safe harbor provision look like?
The following is an eloquent example from Kansas statutes of a common-sense safe harbor exemption to ensure nutrition services continue to be available to as many citizens as possible.
KANSAS STATUTES ANNOTATED: Article 59 – DIETITIANS
65-5912. Construction of act; exemptions. (a) Nothing in this act shall be construed to require any insurer or other entity regulated under chapter 40 of the Kansas Statutes Annotated or any other law of this state to provide coverage for or indemnify for the services provided by a person licensed under this act.
(b) So long as the following persons do not hold themselves out to the public to be dietitians or licensed dietitians or use these titles in combination with other titles or use the abbreviation L.D., or any combination thereof, nothing in this act shall be construed to apply:
(1) To any person licensed to practice the healing arts, a licensed dentist, a licensed dental hygienist, a licensed professional nurse, a licensed practical nurse, a licensed psychologist, a licensed masters level psychologist, a licensed pharmacist or an employee thereof, a physician assistant, a licensed professional counselor;
(2) to any unlicensed employee of a licensed adult care home or a licensed medical care facility as long as such person is working under the general direction of a licensee in the healing arts, nursing or a dietetic services supervisor as defined in regulations adopted by the secretary of health and environment or a consultant licensed under this act;
(3) to any dietetic technician or dietetic assistant;
(4) to any student enrolled in an approved academic program in dietetics, home economics, nutrition, education or other like curriculum, while engaged in such academic program;
(5) to prevent any person, including persons employed in health food stores, from furnishing nutrition information as to the use of food, food materials or dietary supplements, nor to prevent in any way the free dissemination of information or of literature as long as no individual engaged in such practices holds oneself out as being licensed under this act;
(6) to prohibit any individual from marketing or distributing food products, including dietary supplements, or to prevent any such person from providing information to customers regarding the use of such products;
(7) to prevent any employee of the state or a political subdivision who is employed in nutrition-related programs from engaging in activities included within the definition of dietetics practice as a part of such person’s employment;
(8) to any person who performs the activities and services of a licensed dietitian or nutrition educator as an employee of the state or a political subdivision, an elementary or secondary school, an educational institution, a licensed institution, or a not-for-profit organization;
(9) to any person serving in the armed forces, the public health service, the veterans administration or as an employee of the federal government;
(10) to any person who has a degree in home economics insofar as the activities of such person are within the scope of such person’s education and training;
(11) to any person who counsels or provides weight-control services as a part of a franchised or recognized weight-control program or a weight-control program that operates under the general direction of a person licensed to practice the healing arts, nursing or a person licensed under this act;
(12) to any person who is acting as a representative of a trade association and who engages in one or more activities included within the practice of dietetics as a representative of such association;
(13) to a licensed physical therapist who makes a dietetic or nutritional assessment or gives dietetic or nutritional advice in the normal practice of such person’s profession or as otherwise authorized by law;
(14) to a dietitian licensed, registered or otherwise authorized to practice dietetics in another state who is providing consultation in this state;
(15) to any person conducting a teaching clinical demonstration which is carried out in an educational institution or an affiliated clinical facility or health care agency;
(16) to any person conducting classes or disseminating information relating to nonmedical nutrition; or
(17) to any person permitted to practice under K.S.A. 65-2872a, and amendments thereto.
(c) Nothing in this act shall be construed to interfere with the religious practices or observances of a bona fide religious organization, nor to prevent any person from caring for the sick in accordance with tenets and practices of any church or religious denomination which teaches reliance upon spiritual means through prayer for healing.